Расширение представления о понятии хронической обструктивной болезни легких: концепция Preserved Ratio Impaired Spirometry (PRISm)

Введение. Хроническая обструктивная болезнь легких имеет высокую распространенность, заболеваемость и смертность, что делает актуальной проблему ранней диагностики предшествующих состояний, включая PRISm. Несмотря на растущий интерес к PRISm, патогенез и клинические последствия данного состояния остаются недостаточно изученными.

Цель. Провести поиск и анализ научных данных о PRISm, включая эпидемиологию, патогенез, диагностику, связь данного состояния с другими заболеваниями.

Материалы и методы. Поиск материала осуществлен в электронных базах данных eLIBRARY.ru, КиберЛенинка, PubMed, Cochrane Library за 2009–2025 гг. по ключевым словам. Для анализа были отобраны публикации результатов оригинальных исследований.

Результаты. Анализ современных результатов исследований свидетельствует, что PRISm представляет собой гетерогенное состояние, характеризующееся снижением ОФВ₁ (<80%) при сохранном соотношении ОФВ₁/ФЖЕЛ (>70%). Распространенность PRISm варьирует от 3 до 20% и ассоциирована с такими факторами риска, как курение, ожирение, загрязнение воздуха, метаболические нарушения (например, сахарный диабет 2-го типа) и генетическая предрасположенность. Патогенетические механизмы включают рестриктивные изменения (фиброз, снижение растяжимости легочной ткани), системное воспаление (повышение уровней интерлейкина-6 и фактора некроза опухоли) и окислительный стресс. PRISm ассоциирован с повышенным риском прогрессирования в ХОБЛ, развития сердечно-сосудистых заболеваний и общей смертности, что подчеркивает его клиническую значимость.

Выводы. PRISm является гетерогенным и клинически значимым состоянием, требующим междисциплинарного подхода к диагностике и лечению. Дальнейшие исследования необходимы для уточнения его патофизиологии, разработки стандартизированных диагностических критериев и персонализированных терапевтических стратегий. Результаты современных научных исследований подчеркивают важность раннего выявления PRISm для улучшения прогноза пациентов.

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